What is your process for considering alternative imaging modalities for cardiac imaging when POCUS is limited by patient conditions, such as emphysema or body habitus?

When POCUS is limited, a multi-faceted process that considers the clinical question, patient characteristics, the strengths and limitations of available imaging techniques, and the available resources should be implemented. The most important question is what you are specifically trying to evaluate. For example, are you looking for heart failure, valvular disease, or myocardial ischemia? Then you need to assess the urgency. Is this something that needs rapid diagnosis, or can a more comprehensive evaluation be scheduled later? TEEs offer better image quality and penetration through the chest wall and may be preferred with patients with emphysema or poor cardiac windows. Coronary CT angiography can be used to assess coronary blockages. Cardi...